婦產(chǎn)科 子宮內(nèi)膜異位癥

Endometriosis子宮內(nèi)膜異位癥DefinitionTheendometriumisectopic,locatedinanyothersitethantheliningofthecavityoftheuterus.Iftheendometrialtissueislocatedintheuterusmuscle,itisreferredtoadenomyosis.Whentheuterinewallcontainsmyoma,endometriosiswithinthemyomaisdesignatedadenomyoma.SummaryItismoreofteninprivatethanincharitypatient.Itusuallyoccursbetweentheagesof25and45.Theincidenceisabout10-15%.Itismostfrequentlyintheovary,rectovaginalpouch,rectovaginalseptumanduterosacralligament;itmayoccuronthesurfaceofthepelvicperitoneum,thewallofthebowelorbladder,evenintheabdominalscar.EtiologyEndometriumimplantation:a.transtubalmigrationb.directimplantationc.lymphaticdisseminationorvenouscirculationCoelomiccellmetaplasiaInductiontheoryImmunefactor、HereditaryfactorEutopicendometriumtheoryPathologicchangeEndometriotictissueundergoesthesamearchitecturalandphysiologiccyclicchangeasthenormalendometriumintheuterinecavity,asthereflectionofthestimulationbyovarianhormones.Thelesionsareusuallyencapsulatedandvariableinsize,blueberryincolor,scatteredovertheperitoniuminpelvic.GrossappearanceOvarianendometrioticcyst:a.mostcommon,50%arebilaterallyb.alsocalledchocolatecyst:containdirtylight-blackbrownfluidc.oftenadherestotheposteriorleafofthebroadligament,easytoruptureinthesurgery.HistologicchangeThelesionpresentthecomponentsofnormalendometriumwithextensivefibrosisandhemorrhage.Sometimesit'sdifficulttofindwelldevelopedendometiralglands.Thespiralateriolesdonotoccurinendometriosis.Hemosiderinisformed.SymptomPain.Thepainismostprominentoneortwodayspriortomenstruationandduringthefirstday,eventhroughoutthemenstruation,wecallitdysmenorrhea.Thepainseverityisprogressive.Therelationshipbetweenthedegreeofendometriosisandtheseverityofthesymptomisofteninconsistent.SymptomUterinebleedingHypermenorreaisthemostfrequent.Severedeepdyspareunia:prominentinthepremenstrualphase.Thismayduetothattheendometriosisintherectovaginalpouchorthefixationofpelvicorgans.SymptomInfertilityTheincidenceofinfertilityinthepatientswithendometriosisisabout40-50%.Maybeduetotheinadequatetubo-ovarianmobility,fixedretroversionofuterus,anovulationSymptomIftheendometriosisinvadetherectummucosa,periodicrectalbleedingoccurs.Iftheendometriosisinvadethebladder,maycausehematuria.Theruptureofendometrialovariancystmaytheacuteabdominalpain.PhysicalfindingAbdominalexaminationisusuallynormal.Onpelvicexamination,theuterusisfixedandretroversion,inrectovaginalpouchoruterosacralligamentmaypalpatedirregularnodulewithtenderness.Theovarycystcanbepalpated.DiagnosisBultrasoundscanningSerumCA-125:mayelevated,mostly<200U/MLLaparoscopy:GoldenStandardDifferentialdiagnosisOvarymalignanttumorPelvicinflammatorydisease.TreatmentExpectanttherapyThesymptomisslight,thelesionisalsoslight.Hormonetherapya.Oralcontraceptionpillsb.Long-termlargedosageprogestogen:pseudopregnancyTreatmentPseudomenopausetherapya.Danazol:antigonadotropintoinhibittheovarianhormone200mgbidortidfor6monthsb.Gestrinone:2.5mgbiwc.Mifepristoned.GnRH-?TreatmentConservationsurgery:maintainthechildbearingfunctionLaprascopyisthebestwaytoadequatelyremoveanddestroytheendometriallesion.Semiconservation

surgery:fortheage<45yrsHysterectomywiththeovaryleftRadicalsurgery:totalhysterectomywithbilateralsalpingo-o?phorectomy.Adenomyosis

子宮腺肌癥AdenomyosisItgenerallyappearsinthewomenover35years.mainclinicalfindingsSevereDysmenorrhea.Hypermenorrhea.Afirmsymmetricallyenlargeduterusisacommonclinicalfinding,inthemenseswithtendernes